Mark’s Daily Apple

Metabolic Fingerprinting3

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Identification

Yes, it’s oh-so-middle-school, but we called it! Following the first ever metabolome-wide association study conducted across four countries, researchers are affirming the promise of metabolic fingerprinting in studying the links diet and other lifestyle factors have with specific disease risk. Once again, the focus is on gene expression, the resulting phenotype rather than our initial genetic “text.� Researchers compared levels of several metabolites (particles produced by the metabolic process) that were present in 4,630 subjects, who hailed from the U.S., the United Kingdom, China and Japan.

For the study, researchers took urine samples from volunteers aged between 40 and 59 and analysed these for over several thousand metabolite signals, using NMR spectroscopy and advanced statistics. The volunteers were participating in the INTERMAP study, an epidemiological study investigating the links between diet and blood pressure.

via Science Daily

The conclusions? Fingerprinting of subjects in the U.S. and U.K. indicated similar patterns, but these results substantially contrasted with patterns found in China or Japan. Differences were also significant between the profile results of Chinese and Japanese test subjects. To further confirm the lifestyle basis of these differences, researchers analyzed metabolite levels from Japanese and Japanese-American subjects. The comparative results indicated that Japanese-Americans’ metabolic profiles showed more similarity with other Americans’ metabolic patterns than they did with Japanese profiles. These metabolic patterns complement the difference in disease rates.

As Professor Paul Elliott, one of the study’s authors from the Department of Epidemiology and Public Health at Imperial College explains: “… whereas a person can’t alter their DNA, they can change their metabolic profile by changing their diet and lifestyle. This means that as we figure out where the problems lie, we should also be able to show people ways to reduce their risk of certain diseases.” Hmmm. Where have we heard that before?

This study further confirms our ongoing (and evolving) thesis that, from a genetic perspective, we’re very similar, at least when it comes to how we metabolize food and how our genes express themselves as a result of the foods we eat. Our genetic expression, for every single one of us, becomes the metabolic end product of our diet and lifestyle choices.

Given this study and its impact researchers hope it will have on personal disease risk assessment, you can go to a doctor and pay a lot of money to find out you have the metabolites that indicate a higher risk of certain diseases. (We pretty much know what the tests will show if you eat according to CW, right?) Or you can just concede that when you eat and live healthily (the Primal Blueprint way being our humble suggestion) your profile won’t take the shape of those insidious, high risk metabolic fingerprints.

Hmmm. We’d personally suggest saving yourself a few hundred or thousand bucks. We can think of better ways to unload that kind of cash – maybe a quarter grass-fed cattle order or a CSA share? A week-long trip to the mountains or beach, all in the name of stress relief?

Thoughts? Questions? Send ‘em on.

epadilla Flickr Photo (CC)

Further Reading:

Dear Mark: Gene Expression

Gene Expression: Location, Location, Location

Eye on DNA: Stunning Gene Expression Visualization

Posted: Health, Primal Health, Worker Bees' Weekly Bites

Hormones and Heart Disease9

Balancing Act

We aren’t talking estrogen here, but this latest news does concern the ladies of the community.

In the recent “Hunt Study� conducted by researchers at the Norwegian University of Science, women with thyroid function in the less active part of the “normal� clinical reference range showed an increased risk for fatal coronary heart disease relative to those with numbers in the more active part of the clinical range.

The findings were based on a follow-up with 17,311 women and 8,002 men who had shown no signs of heart disease, diabetes or thyroid disorder at the beginning of the study in the mid-1990s. All participants were 40 years or older when initial tests were done to measure levels of thyrotropin, a hormone released by the pituitary gland that is known to stimulate the thyroid. During the follow-up examinations that were completed in 2004, researchers found that 192 women and 164 men had died of heart disease. Of these subjects, none had shown signs of thyroid malfunction. However, women whose readings showed the relative lowest (but still clinically normal) thyroid gland activity were “69 percent more likely to die from heart disease than women with more active glands.�

Compared with women in the lower part of the reference range (thyrotropin level, 0.50-1.4 mIU/L), the hazard ratios for coronary death were 1.41 (95% confidence interval [CI], 1.02-1.96) and 1.69 (95% CI, 1.14-2.52) for women in the intermediate (thyrotropin level, 1.5-2.4 mIU/L) and higher (thyrotropin level, 2.5-3.5 mIU/L) categories, respectively.

via Archives of Internal Medicine

According to the researchers, “These results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal coronary heart disease.” The researchers noted that lower thyroid function has been associated with traditional risk factors for heart disease: “Emerging evidence indicates that levels of thyrotropin within the reference [normal] range are positively and linearly associated with systolic [top number] and diastolic [bottom number] blood pressure, body-mass index and serum lipid concentrations with adverse effects on cardiovascular health.”

The researchers added that no clinical research has studied the impact thyroid medication might have on this added heart disease risk. The study findings did not show the same connection between thyroid function and fatal heart disease risk for men.

We’ve always made the argument here that health is more than the sum of a few clinically measured parts. It’s ultimately a whole package, an interactive design. Hormone balance is absolutely key to good health, and an imbalance is assuredly sign of wider havoc. Thyroid function is part of the body’s intricate hormonal symphony and is tied to a number of lifestyle related choices and circumstances, including environmental toxin exposure (most notably but not exclusively perchlorate, a chemical used in rocket fuel that is present in water and milk and has been linked to thyroid malfunction in animal studies) and chronic inflammation that may be caused by factors like a consistently poor diet and/or autoimmune disorder.

We always advise making the most of preventative medical care. For women in particular, getting a thyroid function test and talking about the results with your doctor is one step toward knowing more and taking charge.

Questions? Comments? Experiences in this area and suggestions to add?

Further Reading:

Yoga Good for Reducing Breast Cancer Risk

Top 10 Reasons to Stay Healthy

Questions About Soy Formula

Posted: Health, Prevention, Worker Bees' Weekly Bites

The Heparin Controversy7

Bag of Trouble

This morning’s New York Times reports that the FDA is now echoing what many scientists and industry experts have been saying for weeks: the contaminated stores of heparin that have been associated with 81 deaths and 785 severe allergic reactions in the U.S. was likely adulterated on purpose. In March, the FDA issued a major recall of heparin following increasing reports of adverse reactions and deaths connected with the drug.

Tests have shown that heparin components made by a company in China (Changzhou SPL) were contaminated by a manipulated form of a dietary supplement, oversulfated chondroitin sulfate. Because the cheaper additive resembles heparin, routine screening didn’t reveal the contamination. Contaminants comprised up to a third of some heparin samples that were tested. Dr. Janet Woodcock, director of the Food and Drug Administration’s drug center explained, “[I]t does strain one’s credulity to suggest that might have been done accidentally.�

Heparin is a blood thinner used in dialysis, heart surgery and other medical treatments. Components, known as active pharmaceutical ingredients or APIs, of the drug were made by the Chinese company and then used by Baxter International to manufacture the final product.

Earlier this week family members whose loved ones had died after receiving the drug spoke before a Congressional subcommittee, as did FDA officials and leaders of Baxter International, who support the claim that the heparin ingredient was deliberately contaminated.

The incident has caused a major uproar on Capitol Hill with members bearing their teeth for cameras. As recent commentary in the New England Journal of Medicine notes, the target of their ire is the FDA, the federal agency in charge of regulating “$1 trillion of consumer products or 25% of the U.S. consumer economy� with a budget of “$1.57 billion — less than 75% of the budget for the school district in its home county in Maryland.� The FDA doesn’t have anywhere in the ball park enough to cover the inspection needs of today’s global marketplace. At best, the agency has the manpower and funding to inspect 7% of foreign drug/API manufacturers. Despite switching to a risk-based model to prioritize inspections, the inspection system is fraught with issues, including an inability to perform inspections without notification and limitations in inspection thoroughness because of inadequate translation services.

While the FDA is being grilled over hot coals, little if any complaint is being directed at Baxter International itself, the company that outsourced the production of the heparin components in order to enhance its profit and not conduct its own inspections to ensure safe manufacturing practices. Before the anti-capitalist accusations start slinging our way, it’s important to note that we have nothing against companies making money. (Shouldn’t that be obvious?) But the question of the day is who will protect consumers from the deleterious effects of adulterated drugs? Call us what you will, but we believe people should be able to take the drugs they need without wondering if they’re getting what the label says they’re getting or if they’re playing a medical version of Russian roulette.

And as for the argument that the companies will choose to ensure safe practices in order to avoid lawsuit? Well, the heparin controversy is case in point to show companies don’t always operate on those principles. Some do, some don’t. And it may only get worse. As another commentary from last week’s NEJM noted, this February the Supreme Court ruled that FDA approval of medical devices “precludes lawsuits brought by patients against the manufacturer over adverse events in state courts.� As a result of this ruling, patients cannot bring a lawsuit (or truly expect to win one anyway) when harmed by a medical device that the FDA has previously certified as “generally safe and effective.� The Supreme Court will hear a “similar case� regarding pharmaceuticals later this year. This should get interesting.

We aren’t, are not, in no way, shape or form, arguing against a free market. But the “market,� as we know, serves people – mothers, fathers, kids, grandparents, neighbors and friends. We simply can’t have it every way: no inspection responsibility for manufacturers, no real money or authority for a federal regulation agency, and (potentially, later this year) no recourse for patients and their families.

With more than 80% of drugs or pharmaceutical components now made in other countries (primarily China and India) the problem isn’t going to magically dissipate into the atmosphere (although it might disappear into the back pages of newspapers for a while as other events grab the media’s attention). Fixing this debacle takes some hard questioning about how we want our system to operate. The question becomes: who should we trust as we swallow that prescription? Bottom’s up!

Tell us what you think.

flippy rice Flickr Photo (CC)

Further Reading:

Deconstructing Healthcare in America - A Modest Proposal

Where Have All the Studies Gone?

Pharmalot: Should Drugs Carry Country of Origin Labels?

Posted: Big Pharma, Worker Bees' Weekly Bites

News on the Seedling Front4

Protect those seedlings!

A report out this week offered some of the latest news on children’s health in the United States. Researchers from Duke University and the Foundation for Child Development studied trends in the health of children up to eleven years of age. We always want the good news first, right?

Researchers found some (very) positive trends, including “dramatic improvements� in mortality rates. The mortality rate for children one to four years of age in 2005 was 29.4 per 100,000 births compared with 42.9 per 100,000 just eleven years earlier in 1994. Death rates in middle childhood fell by 27% during the same time period. Finally, lead poisoning levels have fallen by 84%. Now that’s news worth celebrating.

On the flip side, however, researchers confirmed what other studies (and a quick look around the mall) have suggested. The report says the overall health of American children is now compromised by higher obesity rates and an increase in the percentage of babies born with low birth weight.

While U.S. children overall have seen improvements in their well-being in recent years, American children aged 6 to 11 are four times more likely to be obese than similarly aged children in the 1960s, the report found. …The researchers found obesity among children in middle childhood is nearly four times more common than in children of the same age in a national survey in 1960s. For children aged 2 to 5, it is three times higher. …They also found that the percentage of babies born with low birth weight rose 12.3 percent from 1994 to 2005, an increase they said was likely tied to delayed childbearing among working mothers and an increased use of fertility drugs. Low birth weight has been linked in large studies to a higher risk of developmental and learning problems and to lower academic achievement. It also has been linked with higher rates of chronic health conditions.

via Yahoo! News

Unfortunately, the bad news doesn’t end there.

Another recent report by a California-based health care provider estimates that the diabetes rate among pregnant women skyrocketed between 1999 and 2005, doubling in number. Researchers based their estimate on the records of over 175,000 mothers who gave birth in a consortium of hospitals between 1999 and 2005. Diabetes in pregnancy results in higher risk of birth defects, miscarriage, and stillbirth. As mentioned yesterday, women who have developed insulin resistance can pass that condition on to their children.

Clearly, we have the medical knowledge and resources available to ensure the health of our children and save lives. The improvement in mortality rate is a testament to that potential. Nonetheless, we struggle with the most basic principles of healthy living, and our children are suffering for it. Diabetes and its associated risks as well as childhood obesity threaten to undo the benefits modern medical developments offer. And as for the rise in low birth weight, though the researchers chose to chalk it up to fertility drugs and older mothers, there are plenty of other primary causes for low birth rate, including poor nutrition, abnormal pre-pregnancy weight, smoking, anemia, multiple gestation and medications or conditions that inhibit nutrient absorption. Hmmm. How common might those be in women of child-bearing age in our country today?

The bottom line is this: our society has yet to make a real commitment to children’s total health and well-being. Every player in the game (schools, parents, businesses, government, etc.) could do better. Our conceptualization of health care is too heavily based on a condition treatment model. No condition? No care or concern necessary. Health is more than a lack of symptoms and disease. It’s a spectrum of wellness with lack of disease and symptoms not on the positive end but smack dab in the middle. We’re failing our kids with our low health expectations, which we pass down to them like we apparently do our myriad of medical conditions.

Comments? Rants? Solutions? Share ‘em please.

Beppie K Flickr Photos (CC)

Further Reading:

School Menu Trends - ‘A’ for Effort?

That’s Fit: Babies Need Sleep to Protect them from Obesity

fitsugar: Gym for Kids?

Posted: Health, Prevention, Raise Healthy Seedlings, Worker Bees' Weekly Bites

Urban Areas Becoming Supermarket “Deserts”2

Where have all the grocery stores gone?

A study published in the International Journal of Health Geographics suggests that as more and more supermarkets leave cities to set up shop (literally!) in the suburbs, urban areas are increasingly at risk of becoming “food deserts.�

For the study, researchers at the University of Western Ontario in London, Ontario, used geographic mapping techniques to map the locations of supermarkets in 1961 and 2005 and then analyzed the results based on neighborhood location, socioeconomic characteristics and access to public transportation.

Based on this analysis, the researchers determined that fewer than 20% of residents living in the “urban core� of London have access to supermarkets today, down from more than 75% who had easy access in 1961. They also note that spatial disparities in access to supermarkets have increased significantly, with residents of inner city neighborhoods with the lowest socioeconomic characteristics experiencing the poorest access to supermarkets.

Although this study was conducted in Canada and focuses only on supermarkets in London, Ontario, the researchers note that similar trends have been observed in Northern America as well as the United Kingdom.

So what’s causing the exodus? The researchers hypothesize that increased urban development as well as the constant need for space could partially be to blame, but note that in the end, it all comes down to dollars. You see, supermarkets need to be located in affluent areas in order to be successful and have actually begun targeting their product lines (i.e. catering to those searching for “one-stop-shopping�) in order to meet the needs of the suburban market.

Now, if you’re wondering what us city dwellers do, you’re pretty much in the same position as urban planners and public health policy experts. Why would they get involved? Well, the bottom line is that access to food – and produce in particular – is directly associated with health. In fact, a report by the New York City Department of Health has suggested that neighborhoods with the least access to fresh produce have greater rates of obesity, which in turn increases the likelihood of chronic disease, including type 2 diabetes, heart disease and certain types of cancer.

But before you get all bogged down and begin to think that the poor city mice are starving, consider this: many large cities have taken steps to increase access to fresh produce. In New York City, for example, lawmakers recently passed legislation to add 1,000 more “green carts,� that is, vendor stands serving only fruits and vegetables, to the city’s existing fleet of 4,000. While these carts have traditionally been clustered on the city’s wealthy Upper East Side, this time, the permits require the carts to be set up in low-income and otherwise under served neighborhoods, where access to fresh produce is often scarce.

Elsewhere, many cities are jumping on the farmers’ market bandwagon. According to recent statistics from the U.S. Department of Agriculture (USDA), the number of farmers’ markets nationwide increased more than 7 percent from 4,093 in 2005 to 4,385 in 2006. As a result of this increase, total sales volumes for farmers’ markets increased from an estimated $888 million in 2000 to about $1 billion in 2005, with 25% of farmers participating in a recent survey reporting that they relied on farmers’ markets as their sole source of farm-based income. Furthermore, the USDA has created programs such as the Women, Infants and Children (WIC) Farmers Market Nutrition Program and the Senior Farmers’ Market Nutrition Program to both support the farmers and ensure that low-income residents have access to fresh produce.

So while the study does support the theory that supermarkets are declining in urban areas (and what they do stock isn’t worth showing off in a fruit bowl!), it would seem that city residents have a number of new options for obtaining produce.

Don’t have any farmers’ markets in your area? Visit this site for information on who to contact and what to do about adding one in your town!

kansasexplorer, Steve Crane Flickr Photos (CC)

Further Reading:

It’s My Neighbors Fault I’m Fat

The Poor Body

High-Density Fast Food Joints = High-Fat Fast Food Eaters

Posted: Health, Worker Bees' Weekly Bites